Folk medicinal practitioners (otherwise known as Kavirajes or
Vaidyas) are a common feature, particularly in the rural areas of
Bangladesh. The origins of folk medicine are unknown, but may reflect a
unique blend of other more established forms of traditional medicines in
Bangladesh like Ayurveda and Unani combined with the personal
experiences of the Kaviraj, which may be a totality of knowledge
acquired through multiple generations as well as gathered from
'gurus' or reading books on medicinal values of plants. Since
the practice of being a Kaviraj is usually kept within the family and
passes in most cases from father to son or daughter and so forth, or in
some cases acquired by serving as an apprenticeship to a
'guru' or master, over time, depending on the accumulated
years of experience, a Kaviraj may possess considerable knowledge on the
medicinal properties of plants. There are also anecdotal reports as well
as reports by individual Kavirajes that they have gone to Assam state in
India to get training from a master. Assam state, and particularly the
district of Kamrup in Assam, is particularly known among the Kavirajes,
who besides using medicinal plants and animal parts, also deals with
healing of paranormal diseases through incantations, amulets and black
magic. Other Kavirajes mention that they have acquired their knowledge
through perusal of Ayurvedic, Unani or folk medicinal texts written for
the lay persons. It may be mentioned in this regard that the Kaviraj
community as a whole in Bangladesh do not have higher education (or in
most cases have only primary school education or not even that), nor are
they required to undergo professional training and obtain certification
before they can practice. As such, any person can start practicing as a
Kaviraj based on whatever training or knowledge that the person has
learnt or collected.

Studies and documentation of folk medicinal practices are
practically absent in Bangladesh. Most Kavirajes have been dismissed as
mere quacks by the influential, intellectual and affluent sections of
the society. Yet there is much anecdotal evidences that suggest that
quite a large number of Kavirajes have very extensive practices and are
visited by affluent sections of the society, who can afford advanced
allopathic medicine, and have indeed gone to highly trained allopathic
doctors, but have not been successful in cure of their diseases. The
evidences also suggest that Kaviraj treatment has succeeded where
allopathic treatment has failed. This is not surprising for most
Kavirajes use medicinal plants and animal parts for treatment and modern
science has recently began to re-discover the medicinal values of these
plants and animals. That plants and animal parts have therapeutic values
cannot be denied, for not only many allopathic drugs have been
discovered from plants from close observations of the traditional
medicinal practices of indigenous societies [10,21,36], but also animal
parts have also been extensively used as medicines among indigenous
societies for centuries and have started to prove their values in
disease treatment from modern scientific research [20,74,64,4,5].

Towards a thorough documentation of the medicinal plants of
Bangladesh, we had been conducting ethnomedicinal surveys among folk and
tribal medicinal practitioners of Bangladesh for a number of years
[78,89,90,91,19,42,44,70,71,89,90,91,92,93,94,95,96
,97,98,2,13,14,15,40,47,49,89,90,113,117,23,42,45,5
6,89,90,91,92,93,114]. Such studies not only document the possible
therapeutic importance of the medicinal plants and animal species of the
country, but can also serve as the basis to initiate or continue further
scientific research. As such the objective of the present study was to
conduct ethnomedicinal surveys among folk medicinal practitioners of two
adjoining districts of the country, namely Chuadanga and Jhenaidah.

Materials and Methods

The present survey was carried out in the adjoining villages of
Tangramari and Kutubpur in Chuadanga district and the village of
Benepara in Jhenaidah district of Bangladesh. It may be mentioned that
the two districts adjoin each other. There were two practicing Kavirajes
in Tangramari village, namely Md. Abdur Rahim (designated as Kaviraj 1
in Table 1) and Md. Altaf Hossain (designated as Kaviraj 3 in Table 1).
Kaviraj 1 was male, 55 years by age, Muslim by religion, and had been
practicing for about 25 years and specialized in ethnoveterinary
medicine. Kaviraj 3 was male, 50 years by age, Muslim by religion, and
had been practicing for about 20-25 years. The practitioner at Kutubpur
village of Chuadanga district (designated as Kaviraj 2 in Table 1) was
named Md. Abdur Razzak, male, 40 years by age, Muslim by religion, and
had been practicing for about 15 years. The Kaviraj of Benepara village
in Jhenaidah district was very old but still active. His name was Md.
Afsar Ali Mandal, 111 years by age, Muslim by religion, and had been
practicing for about 47-48 years.

Informed consent was first obtained from all Kavirajes as to
publish their names, age, religion, and any other information that they
provided. All Kavirajes were fully apprised of the nature of our visits
and consent obtained to disseminate any information provided both
nationally and internationally. All Kavirajes spoke Bengali, which was
also spoken by the interviewers; thus interviews were conducted totally
in the Bengali language. Actual interviews were conducted with the help
of a semi-structured questionnaire and the guided fieldwalk method of
Martin [66] and Maundu [68]. In this method, the Kavirajes individually
took the interviewers on guided field-walks through areas from where
each Kaviraj collected his medicinal plants, pointed out the plants and
described their uses. However, on some occasions, the Kavirajes provided
the information first, followed by taking the interviewers on guided
field-walks. Plant specimens as pointed out by the Kavirajes were
photographed and collected on the spot, pressed, dried and brought back
to Dhaka for complete identification by Mr. Manjur-Ul-Kadir Mia,
ex-Curator and Principal Scientific Officer of the Bangladesh National
Herbarium. Voucher specimens were deposited with the Medicinal Plant
Collection Wing of the University of Development Alternative.

Results and Discussion

The three Kavirajes from Chuadanga district were observed, in
between themselves, to use a total of 74 medicinal plants in their
various formulations. Of the 74 plants, 2 plants could not be
identified. The rest of the plants were distributed into 38 families.
Ailments treated by Kaviraj 1 included gastrointestinal disorders, bone
fracture, tonsillitis, infertility in woman, snake bite, cancer,
swelling of body (edema), cuts and wounds, allergy, pain, sprain, sexual
problems, menstrual disorders, piles, insanity, eye disorders, dog bite,
skin infections, abscess, and paranormal diseases like being touched by
'evil wind' or 'ghosts'. Kaviraj 1 also treated
diseases of domestic animals, and on most occasions the same plant was
used for treatment of the same disease in both humans and animals.
Diseases treated by Kaviraj 2 included infertility in woman, bleeding
while pregnant, rheumatism, sprain, snake bite, skin infections,
insanity, cancer, abscess, and sexual disorders. Diseases treated by
Kaviraj 3 included piles, abscess, gastrointestinal disorders,
infections, excessive water loss from a pregnant woman, pain, sexual
disorders, skin infections, vomiting in children, tuberculosis, fever
with mucus, allergy, and calcium deficiency. Kaviraj 3 also advised
partaking root juice of Solanum virginianum as preventive medicine for
chicken pox. The results are shown in Table 1.

The three Kavirajes of Chuadanga district showed a certain degree
of specialization among them. For instance, Kaviraj 1 specialized in
ethnoveterinary medicine and treatment of paranormal diseases. Kaviraj 2
treated diseases like rheumatism and bleeding in woman who are pregnant,
which problems were not treated by the other Kavirajes. Kaviraj 3
treated excessive water loss from pregnant woman, tuberculosis, vomiting
in children, fever, and calcium deficiency exclusively. Some diseases
were treated in common by the Kavirajes; however, plants used for
treatment were totally different. To cite a few instances, infertility
in woman was treated by Kaviraj 2 with a combination of Achyranthes
aspera and Allium sativum, but treated by Kaviraj 1 with a complex
formulation in which one root of Ichnocarpus frutescens and one root of
Hemidesmus indicus were mixed with 12 spices (rhizome of Curcuma longa,
rhizome of Zingiber officinale, seed of Nigellas sativa, fruit of Piper
longum, bark of Cinnamomum verum, leaf of Cinnamomum tamala, fruit of
Capsicum frutescens, seed of Elettaria cardamomum, bulb of Allium cepa,
bulb of Allium sativum, and dried floral bud of Syzygium aromaticum).
The fish, Colisa fasciata (Bengali: Khalse, English: banded gourami) was
fried and made into a mash with the roots of the two plants and plants
parts of the 12 different spices. The mash was to be taken orally with
cooked rice once. Incidentally, this was the only use of a species other
than medicinal plants by Kaviraj 1, while the other two Kavirajes kept
their formulations exclusively to medicinal plants.

Sprain in human beings was treated with Calotropis procera by
Kaviraj 1, but with Rauvolfia serpentina by Kaviraj 2. Kaviraj 2 also
treated snake bite with the same plant. However, Kaviraj 1 treated snake
bite with either Rauvolfia tetraphylla or Aristolochia indica. Skin
infections were treated in common by all three Kavirajes. However,
Kaviraj 1 treated such infections with Abrus precatorius, Kaviraj 2 with
a combination of Dalbergia sissoo and Melocanna baccifera, and Kaviraj 3
treated skin infections with Cassia occidentalis. Kaviraj 3 also treated
skin infections with Neohouzeaua dulloa. Insanity was treated by Kaviraj
1 with Phyla nodiflora, but by Kaviraj 2 with Opuntia dillenii. Abscess
was treated with Tragia involucrata by Kaviraj 1, with Acacia farnesiana
by Kaviraj 2, and with a combination of Annona squamosa and Acacia
catechu by Kaviraj 3. Piles were treated with a combination of Eleusine
indica, Piper betle, and Areca catechu by Kaviraj 1, but only with
Spondias pinnata by Kaviraj 3. This differences in plant selection by
the Kavirajes on the one hand, points to the rich diversity of plants
present in Bangladesh to treat the same disease; on the other hand, it
suggests that every Kaviraj has his or her unique repertoire of plants
for treatment, and which plants he probably has learnt from training,
experiences (which may include actual trials on human beings or
animals), or picked up from other traditional medicinal practices (like
Ayurveda or Unani) in Bangladesh.

Ayurveda has a long history in the Indian subcontinent and dates
back to probably 5,000 years ago. Both Ayurveda and Unani systems are
well-defined systems with their own formulary and a defined system of
cause and cure of diseases. As such, it is very much possible that folk
medicine has either borrowed from any of these two ancient systems (at
least in some parts), or folk medicine is simply a more simplified
version of Ayurvedic and Unani medicines. It is also possible that folk
medicine could have taken some treatment methods from the various tribes
of the country. It is interesting to note that Rauvolfia serpentina,
known in Ayurveda as 'Sarpagandhaa', is used in the Ayurvedic
system for hypertension and as a mild sedative. The plant was used to
treat sprains and severe rheumatism by Kaviraj 2 and could function to
mildly sedate a person when the person has become excited because of the
sprain and consequent pain or because of rheumatic pain. The plant was
also used by Kaviraj 2 to treat snake bite; the Sigibe clan of the Khumi
tribe of Bangladesh also uses the plant for the same purpose [114]. The
local people of Eastern Ghats, India also use the plant to treat snake
bites [85]. The plant, along with Aristolochia indica is used by the
Kurichya tribe of Kannur district, Western Ghats, Kerala, India, to
treat snake bite [108]. Crinum asiaticum, used by Kaviraj 1 for
treatment of tonsillitis, is known in Ayurveda as
'Naagadamani', and is used as an expectorant [57]. Spondias
pinnata, used by Kaviraj 3 for treatment of piles, is known in Ayurveda
as 'Aamraataka'. The Ayurvedic Pharmacopoeia of India
recommends using the stem bark of the plant in hemorrhagic diseases,
which can include bleeding piles (bleeding occurring from hemorrhoids).
Annona squamosa, used by Kaviraj 3 to treat abscesses also has similar
ethnomedicinal uses in India [112]. Aristolochia indica was used by
Kaviraj 1 for treatment of snake bite. The plant has similar use among
the tribes of Chitradurga district, Karnataka India [43], and tribals of
Kinnerasani region, Andhra Pradesh, India [137]. The plant is also used
for treatment of snake bite by tribals and rural folks of West Rarrh
region of West Bengal, India [35] and by the Kani tribals of Agastyar
Hills of Trivandrum district in Kerala, India [107].

Calotropis procera was used by Kaviraj 1 for treatment of pain and
sprains. In Ayurveda, the plant is known as 'Alarka' and is
used for treatment of painful joints and swellings. The plant is also
used in traditional medicines of Rajasthan, India for treatment of pain
[59], and among the Tripuri tribal medicinal practitioners for treatment
of rheumatic pain [65]. Blumea lacera, used Kaviraj 2 for gastric
problems is reported used by eleven tribal communities in the northern
part of West Bengal State in India for gastrointestinal disorders [69].
Eclipta prostrata was used by Kaviraj 1 for treatment of cuts and
wounds. Ethnic groups in Jhansi and Laitpur sections of Bundelkhand,
Uttar Pradesh, India also use the plant for treatment of wounds [55].
Jatropha gossypifolia, used by Kaviraj 3 for treatment of dysentery, is
used in ethnomedicines of Orissa, India for treatment of diarrhea [24].
Ricinus communis, used by Kaviraj 1 to treat headache, is known in
Ayurveda as 'Eranda', and used for treatment of arthritic pain
and pain in the urinary bladder. The plant is used among different
tribes of India to alleviate pain [7].

Leaves, stems or roots of Abrus precatorius were used by Kaviraj 1
for treatment of skin infections. Paste of roots of this plant is also
used by tribals of lower foot-hills of Himachal Pradesh, India to treat
skin infections [83]. In Ayurveda, the plant is known as
'Gunjaa', and seed paste is used to treat vitiligo [57].
Leaves of Cassia occidentalis were used by Kaviraj 3 for treatment of
skin infections and scabies. In Ayurveda, the plant is known as
'Kaasamarda' and is used for treatment of scabies, ringworm
and other skin diseases. Dalbergia sissoo, used by Kaviraj 2 to treat
skin infections, is considered an anti-leprotic plant in Ayurveda and is
known as 'Shimshapaa'. Stems of Trichosanthes dioica were used
by Kaviraj 2 for treatment of fever. Roots of the plant are used to
treat fever by the tribals from Saraswati River Region of Patan
district, North Gujarat, India [116]. Erythrina variegata, which was
used by Kaviraj 2 along with Trichosanthes dioica and Argemone mexicana
to treat fever, is known in Ayurveda as 'Paaribhadra', and is
used in Ayurvedic medicines to treat fever. Eleusine indica is
considered a stomachic in Vietnamese traditional medicine [57]; it was
used by Kaviraj 1 to treat dysentery. Cynodon dactylon was used by
Kaviraj 2 to stop vaginal bleeding from pregnant woman; in Ayurveda, it
is known as 'Duurvaa', and is used to treat bleeding piles and
bleeding from external cuts and wounds; various ethnic groups of Disoi
Valley Reserve Forest of Jorhat District, Assam, India, use the plant to
stop gum bleed [16]. Scoparia dulcis was used by Kaviraj 2 to treat
diarrhea; the plant reportedly is used by the Kurichya tribe of Kannur
district, Western Ghats, Kerala, India to treat stomach pain [108].

Similarity in ethnomedicinal uses of any particular plant species
among various ethnic groups or different regions of the world indicates
that the plant species can form a useful source of treatment for that
disease. It also indicates a high probability of finding
phytochemical(s) from the plant that may serve as an efficacious
treatment for treatment of the disease for which the plant is used. From
that view point, a number of plants used by the three Kavirajes of
Chuadanga district were seen to have similar ethnomedicinal applications
among other tribes and regions in India. Thus these plant species
deserve further scientific studies as to their phytochemical
constituent(s) and pharmacological activities with reference to the
diseases that they are used for treatment.

A number of plants used by the three Kavirajes of Chuadanga
district can be seen to be scientifically validated in their uses from
available scientific reports. The three Kavirajes used, in between
themselves, various plants for treatment of different types of pain.
Calotropis procera, used by Kaviraj 1 for treatment of pain and sprains
has been shown to have analgesic properties in the latex [22], as well
as aerial parts [73]. Opuntia dillenii, used by Kaviraj 2 for treatment
of severe headache, has also been reported to have analgesic properties
[63]. The plant was also used by Kaviraj 2 to treat insanity. The Garo
tribals as well as non-Garo population of Tangail district, Bangladesh
use the plant to maintain mental strength [90]. Butanol extract of the
plant reportedly demonstrated anti-depressant like actions [46].
Kalanchoe pinnata, used by Kaviraj 3 for treating headache, reportedly
demonstrated analgesic and anti-inflammatory activities in ethanol and
aqueous extract of dried stems [67]. Seed oil of Ricinus communis was
used by Kaviraj 1 to treat headache. Antinociceptive activity has been
reported for leaf extract of the plant [128]. For treatment of waist
pain, Kaviraj 1 advised tying the roots of Tragia involucrata to the
waist. Whether this procedure can really eliminate pain is
scientifically debatable; however, anti-inflammatory and analgesic
activity has been reported for root extract of this plant [109].

Hemigraphis hirta was used by Kaviraj 1 to treat diarrhea. The
plant has been reported to contain lupeol [3]; the anti-diarrheal action
of lupeol has been reported [110]. Rauvolfia serpentina was used by
Kaviraj 2 for treatment of severe rheumatism, sprain, and snake bite,
any of which can cause neurological disturbances because of associated
pain or fear. It is interesting that the plant has been shown beneficial
for neuropsychiatric conditions [58]. Also, alkaloids from the plant
reportedly have anti-venom effect [39]. Aristolochia indica contains the
alkaloid aristolochic acid, which has been reported to inactivate Naja
naja venom and reduce hemorrhage caused by Trimeresurus flavoviridis and
Vipera russellii venoms [139,140]. The anti-venom potential of Eclipta
prostrata (used by Kaviraj 1 to treat snake bite) against Malayan pit
viper venom has also been shown [87]. The anti-diarrheal property of
Blumea lacera has been reported [125]. Notably, Kaviraj 2 used the plant
for treatment of gastric problems.

The sole Kaviraj surveyed from Jhenaidah district used a total of
37 plants and 3 animal parts in his medicinal formulations. The plants
were distributed into 30 families. The various ailments treated by this
Kaviraj included respiratory disorders, skin disorders, sexual
disorders, diabetes, fever, snake bite, jaundice, pain, gastrointestinal
disorders, edema, infertility, puerperal fever, rheumatism, burns, cuts
and wounds, and bone fracture. The results are shown in Table 2 (A, B).

It is interesting that although Chuadanga and Jhenaidah districts
adjoin each other, the plants selected by the Jhenaidah Kaviraj were
much different from those selected by the Chuadanga Kavirajes. For
instance, while the Chadanga Kavirajes used Rauvolfia serpentina or
Aristolochia indica to treat snake bites, the Jhenaidah Kaviraj used
Barringtonia racemosa or Aegle marmelos to treat snake bites. The
Jhenaidah Kaviraj (Kaviraj 4) used Rauvolfia serpentina along with
Aristolochia indica and Andrographis paniculata to treat allergy. The
use of Aegle marmelos roots for treatment of snake bite by Kaviraj 4 is
notable and has not been observed in our previous ethnomedicinal
surveys. However, the use of fruits of this plant for treatment of
stomach disorders is quite common in Bangladesh and other parts of
India. The fruits of this plant, following drying, are used by the Mullu
kuruma tribe of Wayanad district in Kerala, India for treatment of
dyspepsia and dysentery [121]. The roots of this plant are used by the
Kurichya tribe in Kannur district, Western Ghats, Kerala, India, for
treatment of dysentery [108]. Fruits of the plant are used to treat
dysentery in children in Dhule district, Maharashtra, India [84], and
for treatment of dysentery by tribals of south Surguja district in
Chhattisgarh State in India [53]. It is noteworthy that the fruits of
the plant are used to treat snake bite in certain parts of India [62].
Pentacyclic triterpenes are present in the fruit, which can account for
its antivenom activity [72].

Kaviraj 4 used Adhatoda vasica for treatment of coughs. This plant
is known in Ayurveda as 'Vaasaka' and is used in Ayurvedic
medicines as an expectorant (during bronchial, pulmonary and asthmatic
disorders) [57]. The anti-tussive action of the plant in polyherbal
formulations has recently been reported [38]. The plant contains
alkaloids with positive effects on inflammatory diseases [17]; extract
of the plant also has been shown to have antitussive effect [26], and a
bronchodilator alkaloid (vasicinone) has been isolated from the plant
[6]. In fact, andrographolide, a constituent of the plant is possibly
responsible for the beneficial effects of the plant against cold,
coughs, and upper respiratory tract infections [50]. Achyranthes aspera
was used by Kaviraj 4 for treatment of diabetes. Anti-diabetic activity
of ethanolic extract of leaves of the plant has been shown in
streptozotocin-induced diabetic rats [60].

A combination of leaves of Andrographis paniculata and Aristolochia
indica were used by Kaviraj 4 for treatment of fever. Andrographis
paniculata, known in Ayurveda as 'Kaalmegha' is considered in
that medicinal system as having febrifuge properties. Andrographis
paniculata is also used in traditional Chinese and Thai medicines for
treatment of fever [50]. The anti-pyretic properties of one of the
constituents of the plant, namely dihydroandrographolide, have been
reported [25]. In Sudan, Aristolochia species are traditionally used for
treatment of fever [31]. Barringtonia racemosa was used by Kaviraj 4 for
treatment of snake bite. Ethnomedicinal uses of this plant for snake
bite treatment has been reported [75]. Analgesic and anti-inflammatory
effects have been observed with fruits of this plant, which effects may
be beneficial for snake-bitten patient [120]. The bark of Oroxylum
indicum, a plant used by Kaviraj 4 for treatment of jaundice, has been
shown to have hepatoprotective activity [131]. Hepatoprotective activity
has also been reported for leaves of the plant [130]. Bark powder is
used for treatment of jaundice in tribal areas of North Maharashtra,
India [9].

Terminalia arjuna was used by Kaviraj 4 as preventive medicine for
cardiovascular disorders. Bark of this plant is considered a very useful
medicine as cardioprotective and cardiotonic in Ayurveda [57], where the
plant is known as 'Arjuna'. In human volunteers, bark of the
plant has been reported to significantly increase mean cardiac output
and significantly inhibit platelet aggregation in diabetic subjects,
thus showing that cardiovascular morbidity may be reduced following
onset of diabetes [86]. Bark extract has also been shown to have
cardiotonic effects on frog's heart in situ [138]. Other reported
beneficial effects of bark of this plant on heart or heart disorders
include protective effects of plant bark against Doxorubicin-induced
cardiotoxicity [124]; significant inotropic and hypotensive effect of
bark, also increases coronary artery flow and protects myocardium
against ischemic damage, reviewed by Dwivedi [30]; protection of rabbit
heart by bark against ischemic-reperfusion injury [34]; cardioprotective
effect of alcoholic extract of bark in an in vivo model of myocardial
ischemic-reperfusion injury [54]; efficacy of the plant in chronic
stable angina [29,12]; beneficial effects of bark of the plant in
isolated ischemic-reperfused rat heart [33]; and beneficial effects in
coronary artery disease (significant reductions in anginal frequency)
[28].

Kalanchoe spathulata was used by Kaviraj 4 for treatment of
headache. A Chuadanga Kaviraj (Kaviraj 3) used Kalanchoe pinnata for the
same purpose. It is possible that the Kalanchoe genera plants possess
phytochemical(s) with analgesic properties. A steroidal derivative has
been isolated from Kalanchoe pinnata with anti-inflammatory and
analgesic properties [1]. Analgesic and anti-inflammatory activity of
methanol extract of Kalanchoe gracilis (L.) DC. stems in mice has also
been reported [61]. Analgesic and anticonvulsant effects of extracts
from the leaves of Kalanchoe crenata (Andrews) Haworth has also been
described [79,80]. Analgesic and anti-convulsant effects have further
been reported from leaf extract of Kalanchoe crenata (Andrews) Haworth
[79,80]. Analgesic and anti-inflammatory activities have also been
reported from Kalanchoe spathulata leaf extract [118].

Cassia fistula was used by Kaviraj 4 to treat diarrhea. In
Cambodian ethnomedicine, the plant is used to treat dysentery [88]. The
tribal people of Similipal Biosphere Reserve, Mayurbhanj district,
Odisha, India, also use the plant to treat dysentery [82]. Edema was
treated by Kaviraj 4 with root of Tamarindus indica. The Kavirajes'
treatment was, however, unusual and consisted of tying the root around
the body for a week. On the other hand, it is interesting that
anti-inflammatory activity has been reported for seeds of the plant
[11,126]. Kaviraj 4 used the flowers of Hibiscus rosa sinensis to treat
infertility. On the other hand, flowers of this plant are considered an
anti-fertility ethnomedicine in parts of India [48]. Anti-fertility
activity has also been reported with a benzene extract of flowers of the
plant in female albino rats [123]. Nyctanthes arbortristis leaf was used
by Kaviraj 4 for treatment of stomach ache. The analgesic activity of
stem bark extract of the plant has been reported [52]. Traditionally, in
India, the plant is used for treatment of rheumatic joint pain [111].

Scoparia dulcis was used by Kaviraj 4 for treatment of dysentery.
The plant has traditional uses in India for treatment of stomach
troubles [115]. The Kurichya tribe of Kannur district, Western Ghats,
Kerala, India, use root extract of the plant to treat stomach pain
[108]. Datura metel were combined with leaves of Argyreia nervosa, and
leaves of Smilax indica along with mustard oil, oil obtained from Bengal
fox, and juice obtained from bulbs of Allium cepa for treatment of
rheumatism by Kaviraj 4. The tribals of Kalakad-Mundunthurai Tiger
Reserve, Western Ghats, Tamil Nadu, India, put a bandage on affected
areas with leaves of Datura metel boiled in water, to get relief from
rheumatic pain [127]. The plant is also used for treating rheumatism in
traditional remedies for joint diseases in Assam, India [77]. Analgesic
properties of aqueous extracts of seeds of the plant have been described
[141]. In vivo analgesic activity of aerial part of Argyreia nervosa has
also been reported [51], and thus could be beneficial in alleviating
rheumatic pain. In Ayurveda, the plant is known as
'Vriddhadaruka', and is considered useful for treatment of
rheumatoid arthritis [32]. Ayurvedic formulation includes Ajmodadi
Churna - a polyherbal formulation containing root of this plant for
treatment of rheumatic affections [75]. Analgesic activity has been
described in methanolic extract of roots [8]. Thus, the combination of
Datura metel and Argyreia nervosa can be an effective combination for
relief of pain, which occurs during rheumatism, but whether such
combination can actually cure rheumatism remains to be scientifically
determined. The purpose of use of Smilax indica with the other two
plants is unknown. However, a related species, Smilax macrophylla, has
ethnomedicinal uses in the West Rarrh region of West Bengal, India, for
treatment of diarrhea [35]. Since the Kaviraj formulation was advised to
be taken orally, and other ingredients in the formulation like fat of
Bengal fox may cause possible stomach upsets, so Smilax indica was used
to counter this problem. Juice of Allium cepa bulbs reportedly has
analgesic and anti-inflammatory properties [76], and as such, can add to
the pain-alleviating effect. The meat and fat of Bengal fox is widely
considered in Bangladesh as being effective for rheumatism; fox meat is
often advised by Kavirajes to be taken in the cooked form by rheumatic
patients.

Vitex negundo was used along with Azadirachta indica and Thevetia
peruviana for treatment of burna, and large-sized cuts and wounds. These
disorders can cause pain and inflammation, and can become infectious.
The analgesic and anti-inflammatory properties of Vitex negundo has been
reported [129,27,37]. The plant is known in Ayurveda as
'Nirgundi', and is considered anti-inflammatory. Analgesic,
anti-inflammatory and anti-pyretic activities have been reported for
Azadirachta indica leaf extract [81]. The plant is known in Ayurveda as
'Nimba' and is considered anti-microbial, and so can prove
useful in infections developing from cuts and wounds or burns. The
plant, Cissus quadrangularis, was used with Allium cepa by Kaviraj 4 for
treatment of bone fracture. A number of studies have demonstrated the
healing effects of Cissus quadrangularis on bone fracture
[132,133,122,134,135,136,18]. Cissus quadrangularis is also considered
an Ayurvedic plant, where it is known as 'Asthisamhaara', and
is used for bone healing [57]. The use of Allium cepa may have been to
mitigate the pain arising from bone fracture; the analgesic effect of
bulb juice of this plant has been discussed above. Moreover, the wound
healing activity of Allium cepa has also been described [119]. Zingiber
purpureum was used by Kaviraj 4 to treat stomach pain. The plant is
known in Ayurveda as 'Vanardraka', and is used in Ayurvedic
medicines to treat diarrhea and colic. Rhizomes of a related species,
Zingiber officinale, have been shown to give pain relief in patients
suffering from dysmenorrheal [106].

In conclusion, several points may be observed in the present study.
First, the folk medicinal practitioners (Kavirajes) of Bangladesh have
areas of specialization in both selections of medicinal plants and
diseases treated; this rich diversity among the Kavirajes needs to be
documented as extensively as possible for scientific reasons and
alleviation of human sufferings from various diseases. Second, the
Kavirajes possess quite extensive knowledge on the medicinal properties
of various plant species, as evidenced by scientific validation of quite
a number of the plant species used by the Kavirajes. Third, similar
ethnomedicinal uses of the plants used by the Kavirajes of Bangladesh
have been reported from other tribes and regions besides Bangladesh;
this consensus of opinion about the selectivity of a medicinal plant for
treatment of a particular ailment suggests a strong possibility of
discovering efficacious drugs from the plants. Finally, documentation of
such traditional knowledge can spur both scientific interests and
conservation efforts. As such, more ethnomedicinal surveys need to be
carried out among the Kavirajes of Bangladesh. Adequate scientific
validation of the medicinal plants used by the Kavirajes can also
provide the people of Bangladesh, and indeed the world, with a cheap and
alternative source of medicines.

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[111.] Sah, A.K., and V.K. Verma, 2012. Phytochemicals and
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